NEWBORN INFANT

Neonatology Division
Dept. of Child Health Medical School
University of Sumatera Utara

Gradation of Country
Develoving depend on :
GNP
Expective Life
Infant Mortality Rate (IMR)

Jepang
: 3.4

Singapura
: 2.6

Indonesia
: 39.5

PERINATOLOGY

Pediatrics

Obstetrics

Perinatology

Perinatology Coverage

22 weeks
(GA 5 month)

Obstetric
(pregnancy monitor)

Born

1 Mon

Pediatric
Neonatologist
(intensif care)

Neonatal care
Level I : - Healthy neonates
- Rooming in
Level II : - Low dependent
- High dependent
Level III : Neonatal Intensive Care Unit
(NICU)

Normal newborn :
Term infants

: 37 42 weeks GA

Birth weight

: 2500 4000 g

Birth Length

: 44 53 cm

Head circumference : 32 - 37 cm
Apgar Score

: 7 10

Congenital anomalies : negative

Perinatal period :
Statistic usage:
28 weeks ------- 1 week after birth
Science and Service usage :
conception ----- 1 month after birth
Neonatal period :
Birth--------- 1 month after birth

Fetus
*

Neonates

* Fetal circulation

* Neonatal circulation

* O2 depend to Utero

* O2 own produce

placental circulation
* Nutrition depend on
maternal status

by breathing
* Feed ---- Breast feeding

NEONATAL ADAPTATION
Birth

Fetus

Resuscitation

Neonate

Adaptatio
n

NEONATAL ADAPTATION
Adaptation :
the process by which one
adjusts
and becomes more
attuned to the environment.

Neonatal adaptation

Functional adjustment from

intrauterine to extrauterine life
Ability to adjust --- HOMEOSTASIS
Maladaptation --- Morbidity

NEONATAL ADAPTATION

ADAPTATION depend
on :

MATURATION

NUTRITIONAL STATUS

TOLARANCE

ADAPTIVE CAPACITY

NEONATAL ADAPTATION

ADAPTATION depend on :

MATURATION
Related to gestational
age

NUTRITIONAL STATUS

TOLARANCE

ADAPTATION

NEONATAL ADAPTATION

ADAPTATION depend on :

MATURATION

NUTRITIONAL STATUS

Related to birth
weight

TOLARANCE

ADAPTATION

NEONATAL ADAPTATION
ADAPTATION depend on :

MATURATION
NUTRITIONAL STATUS
TOLARANCE
The ability to overcome
the new environment
Tolerability to hypoxia,
hypoglycemia, caloric intake,
etc.

ADAPTATION

NEONATAL ADAPTATION

ADAPTATION depend on :

MATURATION
NUTRITIONAL STATUS
TOLARANCE
ADAPTIVE CAPACITY
the potential or ability
of a system to adapt to
the effects of change

NEONATAL ADAPTATION
Adaptation involved
multiorgan function,
include :
Cardio-circulatory system
Respiratory system
Intestinal tract
Metabolism
Central nervous system

Circulatory Adaptation
Fetus -

from 8 weeks until birth organs

mature to support external life

Fetal circulation
umbilical-placental circuit via umbilical cord
circulatory shunts to bypass
Liver
ductus venosus to inferior vena cava
Lungs
@ foramen ovale between right & left atria
@ ductus arteriosus connects pulmonary artery
to aorta

CIRCULATORY ADAPTATION

Umbilical vein
Ductus venosus
Foramen Ovale
Ductus arteriosus
Pulmonary circ.
Systemic circ.
Umbilical artery

CIRCULATORY ADAPTATION
DUCTUS
VENOSU
S
BY PASS

CIRCULATORY ADAPTATION

BY PASS
II
FORAMEN
OVALE

CIRCULATORY ADAPTATION

BY PASS

PATENT
DUCTUS
ARTERIOSUS

III

CIRCULATORY ADAPTATION
FETAL CIRCULATION
High pulmonary resistance
Low resistance in systemic blood flow

RIGHT to LEFT
shunt
Foramen Ovale
(Left arterial pressure low because returned lung blood is
low and right atrial pressure high due to large volume of
blood from placenta)

Ductus arteriosus
(High pulmonary resistance, Low fetal systemiv blood and
prostaglandin function)

CIRCULATORY ADAPTATION
NEONATAL CIRCULATION

Profound changes of circulation at birth

Increased pulmonary blood flow due to the

drops of pulmonary resistance - lung
expansions.

Venous return from lung increase.

Left arterial press. is raised; Right

art.press.decrease
foramen ovale closed.

Systemic resistance higher than pulmonary

resistance
(24 hours) Prostaglandin
function Ductus close

Constrict umbilical arteries and placental blood

stops.

NEONATAL ADAPTATION

NEONATAL
FETAL
CIRCULATION

CIRCULATION

NEONATAL ADAPTATION
CIRCULATORY ADAPTATION
Fetus
Pulmonary
circulation

Newborn

Active, less
develop.

Active, increased
development

Foramen ovale

Open

Close

Ductus arteriosus
Botali

Open

Close

Ductus Venosus
Arantii

Open

Close

Active with low

resistance

Active with
increase
resistance

Systemic
circulation

Circulatory
Adaptation

FETAL PULMONARY
DEVELOPMENT
Alveoli present : 25
weeks fill with lung fluids
Breathing movements:
Intermittently
Lung developments
Control of
breathing
Fetus : gas exchange
placenta

NEONATAL ADAPTATION
Temperature
Touch

Pain

Proprioceptive
FIRST
BREATH

Diafragm

Mechanical

Chemoreceptor
Neonatal Respiration
Irregular
Abdominal respiration

PULMONARY ADAPTATION
CHAIN OF EVENTS AFTER FIRST
BREATH :

Converts fetal to adult circulation

Empties the lung fluids.

Begin pulmonary function.

THE
NEWBORN
RESPIRATION
BEGIN

PULMONARY ADAPTATION

FETUS

NEWBORN

Alveolus

Colaps

Develops

Pulmonary vessels

Non active

Active

Pulmonary
resistance

High

Decrease

Pulmonary blood

Low

Increase

Oxygen needs

Placenta

Lung

CO2 excretion

Placenta

Lung

Progressive developments of the

duodenum, liver, pancreas and biliary
apparatus

Gest.Age 4 wk

Gest.Age 6
wk
Duodenum : occluded - reformation of lumen X
atresia
Liver & biliary : Begin at 6 and 12 weeks failure to
canalization X biliary atresia
Pancreas : Insulin secretion and glucagon - 10 and 15

GASTRO INTESTINAL
ADAPTATION
FETUS :
Caloric and nutritional needs derived from
mother

placenta.
Intestinal motility non active
No need for enzyme metabolism.
NEWBORN
Intestinal motility begin in function.
Increase needs of calori/nutritional and
enzyme metabolism

NEONATAL ADAPTATION
GASTROINTESTINAL
ADAPTATION
Fetus
Nutritional
absorption
Bacterial
colonization
Feces
Enzyme

Newborn

Non active

Active

Negative

Positive

Meconium

Meconium
Feces

Non function

Active

UROGENITAL ADAPTATION
Renal organogenesis a continuous process

6 till 36 weeks gestation

The developments of urogenital funtion
continuous after birth
Fetal urine production maintaining
amniotic
fluid volume
More than 90% newborn void in the first 24
hours.
Newborn urine production : 1-2 ml/kg
BW/hour.

UROGENITAL ADAPTATION
ALLERTNESS
OLIGOHYDRAMNIOS
May suggest renal agenesis; hypoplasia; dysplasia;
urinary tract obstruction.

POLYHYDRAMNIOS
Gastrointestinal anomalies; transplacental transfusion
syndr.; congenital DM

DELAYED MICTURITION (>48 hours)

Inadequate renal perfusion (Hypovolemia/hypoxia);
Failure urine production; urine flow obstruction.

IMMUNOLOGIC STATUS of
the FETUS and
NEWBORN
FETUS :
Phagocytic cells
Granulocytes cells
Monocytes cells

Identified at 4
mo gestation.

NEWBORN :
Immune system even in term - lower than adults.
Between 3-12 mo transient immunodeficiency.
The risk enhance by :
Prematurity
Traumatic delivery
Neonatal stress, etc.

PREVENTION FROM INFECTIONS

Body
Body Temperature
Temperature in
in the
the NB
NB
37.5 C

Normal range
36.5 C
36.0 C

Cold stress ---------- Cause for concern

Moderate hypothermia --- WARM BABY

32.0 C
Severe hypothermia / outlook grave
Skilled care urgently needed

TEMPERATURE ADAPTATION
FETUS :
Body temperature intrauterine
environment
NEWBORN :
Expose to extra uterine condition
homeothermy capabilities is
limited due to : large surface area; poor
thermal insulation; low ability
to
conserve heat.
PREVENT OF HEAT LOSS

HEAT LOSS.
CONDUCTION

Transfer of body heat

to skin surface.

CONVECTION
EVAPORATION
RADIATION

Dry and wrap the

baby Place in a warm
mattress

HEAT LOSS
CONDUCTION
CONVECTION
EVAPORATION

Skin heat loss depends

on air temperature/flow.

RADIATION

Wrap the baby and

control room
temperature

HEAT LOSS.
CONDUCTION
CONVECTION
EVAPORATION
RADIATION

Depend upon air

humidity

Control humidity
and room
temperature

HEAT LOSS
CONDUCTION
CONVECTION
EVAPORATION
RADIATION

The transfer of body heat

to environmental
temperature

Radiant heater and

control room
temperature